Failure of metal-backed patellar components has been attributed to insufficient polyethylene thickness around the periphery of the metal backing and the absence of an anatomically deep trochlear inset in the femoral component. Our preferred patellar compo-nent31 has a modified dome-shaped polyethylene button that has a minimum 3 mm thickness around the periphery, and no overhanging polyethylene (Fig. 7.2). Patellar component fixation is augmented by three integral peripherally placed smooth pegs inserted into a planed flat bed. The thickness of the metal-backed patellar component can be accommodated without over-thickening the patella-implant complex by countersinking the implant 2 to 3 mm into the reamed bone bed. This is an essential surgical step in order to prevent the recent problems with metal-backed patellar components.
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